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• - r � �. <br /> . �'���8�' �1�I�LQC��,�� � <br /> ��0�����/�l��l������a�/�'�,���a�9�f�d�f�i���O��I���1�I�I��aO`����� <br /> ' Cll"Y O� ��/ER��°� P�RYi�il`� ���VI��� <br /> 3200 Cedar St., �veretf, WA�8201 �25-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDF2ESS•+-� PROPERTYTAX# P M7�`r �✓ /� <br /> tG�� � ���LJS ,�i'L' ' '1t' Vv/I <br /> L�GAL for new construction; Short PlaUsubdivision Lot No. {attach copy of long legal description) ' <br /> OWfVER >:���a4���1`� �,t,a�2�ti=A PhonelE-mail �( Z� -3y�{ - Z'��5� <br /> Add�ess ' ��7 I 0�`i`� �.�•s' Gity/State/Zip r 1.��.:2t,�(� �.L�A -G�5�ti'% . . <br /> AFPLIC!-�NT:_Owner _Owner�s Age�t �Co�ffactof _CoflffaCtoi�s Age�f _,Tefiaflt(mus�provida a letler ofc❑�soN from the owner to dp work In fhe spacej <br /> CQNTRACI"OR �;4e��o����=-C�( �m.i�Rc� �,i- �"��C�l� Stafe Lic,# ���t������l City Bus. Lic.# �"jt:r-�'`L�`7 . <br /> Address ��`�t'�.> { �C.-d�f,� ��--�� �li'r=l(�L�. p�,,t(.� e'G�P1�( PhonelGmail ��-�j.- '��`�j��Z/ <br /> CONiAGT FQR PEF�MIT <br /> ���v itii�v2 5 �„�.w�2, ,,; �n <br /> �tiLv1V=�<- ��4��i�Kw:Q .C��'� <br /> Phone/E-mail �-�j�-'Z��.-3l/`� <br /> BUI�DING PER�ViIT.APPLICATION � cONTRACT PRICE OF WORC�C T � +�-� <br /> Existing Use of Building ����`�� �N ���'�� HEAT 50URCE; ' <br /> ProposedUseofBuiiding L'�F��" ~ `��' �"���'�,` Gas_ Electric�C Other <br /> Building type; ^Single Family ___,Duplex_Townhouse _,Multi-Family ^Commercial <br /> Type of project: _New _Addition _Remodsl _Repair=T.I._Sign_Sprinkler_Demolition_Change Df Use <br /> DESCRIPTION OF WORK(additional space provided on the back): ' <br /> � fZ �C {� ��C1ST�a L� W�; l� 4i,t�'✓:c� U cL��� � <br /> MECHANICAL PERMIT APPLICAlf10P� PLUNi�ING PEIZMIT APPLICATIAN <br /> Type of Projecf: _New_AAdn _Alterafion�,Repair Type of Projecf: _,New_Addn ^Afteration_Repair <br /> SftowNumber(#)offixfures ShowNumber(#f)offixfures <br /> A/C—air handling uniis Toilet <br /> Forced aiP systems Bathtub <br /> Gas piping Lavafory(wash basin). <br /> Water heater Stiower � - <br /> " Gas fireplace 1<ifchen sink&disposal <br /> Gas range Disi�washer � � <br /> Clothes dryer Clothes washer � <br /> Range hood Wate�heater <br /> � Exhausf fan � Sink(seNice/bar/mop/etc,) <br /> � Heat pump Backflow prevente�(inside bldg) <br /> Unit heafer llrinal � - <br /> � Boiler Drinking Fountain � �� <br /> Reirigeration Flaor drain <br /> Woodstove Grease frap <br /> � Ducting � Raof drains � � � <br /> I Other Medical Gas <br /> SF�F�IR�9G�L,�� / ��I�B�I,`�[�.����R'I ���`��6ifl Other: <br /> Number of Heads Other: <br /> I hefe{�y certi(y tftat I ftaVe�ead and examined ihis appllcation and knoW the same 10 be irue and correct.All provisions of laws and ordinances governing ihis lype of work will he complied <br /> wiih whPiher specified herein or not.The granting of a permit does not presume to give authority io violate or cancel ihe provision of any other sta{e or local law regulaiing consinaction <br /> That I am auihorized by ihe owne�of this property to perform the wo�k for which application is made and I comply wilh ihe State Cont��eto�s Law 1Q.27 RCW and 296.200A WAC. <br /> ��'� ' 1 e �� � <br /> (�yarn.�Ttfluthorized tSignature Date (Revjsed4/2095J <br /> • . � �'7j .) <br />